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Working together to improve patient flow

Patient flow is the movement of patients through a hospital from when they are admitted to when they are discharged. It includes the medical care, physical resources and systems needed during this time.

Improving patient flow is a team effort, so tūhono (together) we’ve been developing new, improved processes with input from our performance improvement team, patient flow facilitators, cleaners, orderlies and other kaimahi.

nine people standing around a hospital bed

Left: Salanieta Salome, Team Leader, Carla Clarke, Service Delivery Coordinator, Aniti Akauola, Cleaner, Sarina Khan, Cleaner, Briar McLeod Nurse Unit Manager. Right: Swastika Lal, Charge Nurse Ward 61, Rochelle Morrow, Charge Nurse Ward 76, Leigh Butler, Staff Nurse Ward 78, Shobna Mani, Cleaner.

Improving bed turnaround was identified as a solution to help improve patient flow across the hospital by:

  • moving patients out of AED and CDU and into inpatient ward beds quicker, therefore reducing patients’ waiting time
  • using the Transition Lounge to support patients getting home quicker once they are ready for discharge
  • involving patients in their discharge plan so they know when they can expect to go home.

Each of these, when done right, mean shorter wait times and increased patient satisfaction.

One team that had significant input in this project was our cleaning kaimahi. “In the past, our cleaning kaimahi have not always been aware of who is being discharged when, and only asked to complete a discharge clean once a patient has left,” says Carla Clarke, Service Delivery Coordinator, Cleaning Services.

“In this trial, the ward cleaner’s role involves being aware of the anticipated discharges for the day, so they can plan their work more efficiently and ensure that the cleaning of the vacated room is completed promptly before the next patient is due to arrive.”

Since the pilot to improve bed turnaround kicked off in June, some significant improvements have been achieved, including:

  • 50% increase in the use of the transition lounge
  • 29% increase in the number of patients discharged by midday
  • EDD correct at 8am improved by 16%.

“We have shown that the small things done well with a patient-centred approach can have a positive impact on patient flow,” says Briar McLeod, Nurse Unit Manager General Surgery, Trauma & NZ National Intestinal Failure & Rehabilitation Service. “Recognising our wider team and the impact that we can make together to ensure our patients are where they need to be to receive timely care is integral to the patient journey.”

Feedback from cleaning kaimahi has been entirely positive. “Being included in the planning and feedback process has been very valuable for our team,” says Carla. “Not only is there is a lot of value in having direct feedback from the cleaners involved in the trial – these are the people directly involved in doing the work, so who else would know better where the pressure points and positives are for them – but having the opportunity to have their voices heard and find out for themselves when discharges may occur has been really well received.”

Briar has been impressed by the positive impact of collaboration between kaimahi. “Being part of a team and being valued and acknowledged as well as having some autonomy to plan your day is important,” she says.

Glossary

AED

Adult Emergency Department

Bed turnaround

The time beds are left empty after a patient is discharged and a new patient is admitted.

CDU

Clinical Decisions Unit

EDD

Expected date of discharge.

Inpatient

An inpatient goes to a hospital or clinic for treatment and stays one or more nights.

Transition Lounge

The Transition Service Lounge on level 5 at Auckland City Hospital is a safe, comfortable and convenient place for patients to wait for their discharge to be finalised or to be picked up for transfer home or to ongoing care.

 

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